Provider Demographics
NPI:1922006725
Name:GLENDALE MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GLENDALE MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-821-5500
Mailing Address - Street 1:7401 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7433
Mailing Address - Country:US
Mailing Address - Phone:718-821-5500
Mailing Address - Fax:718-456-0778
Practice Address - Street 1:7401 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7433
Practice Address - Country:US
Practice Address - Phone:718-821-5500
Practice Address - Fax:718-456-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579304Medicaid
NY01579304Medicaid
RL06353210Medicare ID - Type Unspecified